MUSING – Automated Billing Analysis

Everyone knows that someone pays for healthcare, whether it’s the government, an insurer, an individual, or the provider. But it is rare, indeed, that actual costs are known. Insurers review hospital charges and can deny payment for inappropriate billing. For the uninsured, even “charity care” can be a nightmare.

In 2009, 29-year-old Tameka Campwell died at Tampa General Hospital after a four year struggle with a demyelinating disease. She was uninsured, but after her death TGH sued her “estate” for $2.9million. She had no estate, and her mother believes the hospital’s bill was a preemptive move against the family suing for wrongful death. Lawsuits aside, TGH has very little chance of collection even a fraction of that amount, though it could sell the debt to a collection agency. But how truthful was the $2.9m bill?

It is not uncommon for a “community hospital” to charge the uninsured three, five or even eight times the insured rate. This “uncollected” revenue becomes charity that the hospital bestows in recognition of its tax exempt status. By inflating the value of that charity, the exemption for property and income tax appears well justified, at least in the hospital’s public relations front. Good will is an enabler of market domination, which in turn, supports higher prices.

Any healthcare reform that insures everyone guards against this kind of soft fraud. Short of that, public access to automated billing analysis could give a community a better understanding of its tax-exemption cost.